Unruputured ectopic- surgical management

Only if medical Rx won´t work B HCG >3000fetal cardiac activityadnexal mass >4cm*usually laparoscopy...consider salpingostomy/salpingectomy if there is contralateral tubal disease with a strong desire for future fertility.

How do we classify patients with females infertility

ovulatory and anovulatory

How to tell if patient is ovulatory

Lab investigations: #Progesterone on day 21 (>30nmol/L= ovulation) #E2 (oestradiol) on day 12-14, 700-1200 pmol/ L is normal)#Endometrial biopsy, day 24-26: should show a secretory pattern #LH and FSH (>30 IU on two differnt occasions indicates ovarian insuffiencency)

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Evaluating mid-cycle mucus

Charecteristics of adequate mucus -Adequate amount -Ability of mucus to stretch 8-10cm or more -Macroscopic appearance: watery, thin, clear and transparent - When dried on slide, should have ferning pattern on microscopy

* poor mucus production is physical barrier to sperm. may require a procedure to achieve fertilasation.

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Chronic Anoovulation:

1. Obesity 2. Hyperprolactinemia 3. Serum TSH to exclude hypothyroid4.Male factor5. Polycystic ovarian syndrome 6. Clomiphene therapy (may be repeated 3 times) dosage 25mg/day for 5 days (day 5-9 of cycle) Pt usually ovulates between 5th day and 8th day after last tablet, during periovulatory period (day 13 to 16) patient must be monitored for adequate mucus production.

*Hysterosalpingogram & laparoscopy can be done to evaluate tubal motility and patency

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Surgeries done for tubal pathology in infertility

Fimbrioplasty = lysis of adhesions

Neosalpingostomy = creation of new tubal opening in fallopian tube with distal occlusion.